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56 Cards in this Set
- Front
- Back
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Where on the esophagus does esophageal cancer usually occur?
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Middle/lower esophagus
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What are the risk factors for esophageal cancer?
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-Smoking
-Alcohol use -Central Obesity -Diet low in fruits/vegetables -Barrett's metaplasia (Barrett's esophagus) -Achalasia |
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What is achalasia?
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Delayed emptying of the lower esophagus, which causes an increased risk for squamous cell esophageal cancer
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What is Barrett's Metaplasia?
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A precancerous cell that can be reversed with treatment by capsule endo or ablasion
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What are the manifestations of esophageal cancer?
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First appears as an ulcerated lesion
-Progressive Dysphagia (Feels like food is not passing, first meats, then soft foods, then liquids) -Pain (LATE symptom) -If upper esophagus then sore throat, hoarseness, choking -Esophageal stenosis (narrowing of esophagus d/t build up of scar tissue) |
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Does the onset of symptoms in GI cancers occur in late cancer growth or early cancer growth?
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Late
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What are the common sites of metastasis in esophageal cancer?
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liver, lungs
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What are the complications of esophageal cancer?
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hemorrhage, perforation of fistula into lungs/trachea, obstruction
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What is the definitive test to diagnose esophageal cancer?
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Endoscopic biopsy
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What test is used to stage esophageal cancer?
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Endoscopic ultrasound (EUS)
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What test is used to show the extent of esophageal cancer?
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MRI/CT
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What test is used to show narrowing of the esophagus in esophageal cancer?
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Barium swallow with fluoroscopy
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What test is done in esophageal cancer if metastasis is suspected?
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Lung bronchoscopy
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What care may be provided to the patient with esophageal cancer?
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Surgery, Photodynamic Therapy, Radiation and Chemo
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What is photodynamic therapy?
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Photosensitizers are used, They take up neoplastic tissue, avoid sun for 4 weeks
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What is neoadjuvant therapy?
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Chemo/Radiation given prior to surgical procedure to shrink the tumor so that surgery is less extensive
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What is adjuvant therapy?
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Chemo/Radiation after surgery to destroy left over cancerous cells
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What are some palliative options for the patient with esophageal cancer?
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Stents, dilation, laser resection for obstructions
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What things might you look for in a history of a patient who now has esophageal cancer?
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hx of smoking, alcohol, achalasia, hiatal hernia, Barrett's esophagus, GERD
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What is odynophagia?
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painful swallowing
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What pre-op nursing care would be provided for the patient with esophageal cancer?
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-Address nutritional needs (Build up nutritional status prior to surgery), high cal, high protein, IV fluids
-Teaching about chest tube, NG, G or J tube placement |
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What post-op nursing care would be provided for the patient with esophageal cancer?
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-Expect bloody drainage from NG for 8-12 hours, then greenish/yellow
-DO NOT reposition or reinsert tube CALL SURGEON -Semi-fowlers, coughing/deep breathing, monitor for respiratory distress and cardiac dysrhythmia -When patient is PO keep them Fowler's for 2 hours after eating |
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True or false: A patient can have an esophageal stricture with balloon dilation with or without having cancer.
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TRUE
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True or false: by the time of diagnosis of stomach cancer 75% have metastatic disease
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FALSE - 50%
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What are the manifestations of stomach cancer?
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unexplained weight loss, loss of appetite, indigestion, discomfort/pain, anemia (blood loss or pernicious), may feel hard lump in epigastric area, fatigue, pallor, dyspnea, ascites
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What tests are definitive in diagnosing stomach cancer?
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Endoscopy with biopsy, histology of sample
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What tests are used to stage stomach cancer?
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EUS, CT, PET scan
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What test is used to determine peritoneal spread in stomach cancer?
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Laparoscopy
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What lab tests will determine spread of stomach cancer?
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CBC, liver, pancreatic enzymes
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What tumor markers are looked for in stomach cancer?
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CEA, CA-19-9
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What is the aim in treating stomach cancer with surgery?
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To remove as much of the stomach as needed with margin of normal tissue
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What types of surgeries are done in stomach cancer?
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-subtotal gastrectomy (Billroth I & II)
-total gastrectomy with esophagojejunostomy |
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True or false: Radiation and chemo are successful in treating stomach cancer without surgery
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FALSE
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Pre-op care for stomach cancer patients?
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nutrition, possibly blood replacement
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Post-op care for stomach cancer patients who get Billroth I or II?
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NG for decompression (Keep air and pressure out of the stomach that was just sown back together), drainage bloody for 24 hours, suture line care, good abdominal assessment, pain control, IV for fluid and electrolyte replacement
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Post-op care for stomach cancer patients who get a total gastrectomy?
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NG, chest tubes if chest cavity entered, pernicious anemia (cobalamin replacement), dumping syndrome, need vit C,D,K, and B-complex replaced
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True or false: Screening is imperative in colorectal cancer
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TRUE
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Risk factors for colorectal cancer
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intake of processed/red meat, obesity, smoking, alcohol
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Manifestations of colorectal cancer?
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*nonspecific and late in appearing
R side- asymptomatic L side- rectal bleeding, alternating constipation and diarrhea, narrow ribbon-like stool, sensation of incomplete evacuation, more likely to lead to obstruction than right side |
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Tests done for colorectal cancer?
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colonoscopy, Ba enema, virtual colonoscopy, occult blood in stool (FOBT), fecal immunocheminal test (FIT), and stool DNA
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Why is colonoscopy gold standard?
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Can get tissue sample
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What tests/labs are done after colorectal cancer is diagnosed?
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CBC, coagulation studies, LFTs, MRI/CT (for metastasis), CEA to monitor disease progression
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What is the cure for colorectal cancer?
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Surgery (only cure)
Resection of complete tumor, thorough exploration of abd. cavity, removal of lymph nodes that drain into cancerous area, restoration of bowel continuity |
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T/F: All patients with colorectal cancer who undergo surgery get a colostomy placed
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False. It may be not at all, may be temporary, or permanent
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Pre-op for patient with colorectal cancer?
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Bowel prep, ATBs (to reduce colonic bacteria)
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Why is biologic and targeted therapy used in patients with colorectal cancer?
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prevent angiogenesis, treat metastasis
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What is primarily responsible for Liver Cancer?
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Hep C (50-60%)
Hep B (20%) |
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Manifestations of liver cancer?
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difficult to differentiate from cirrhosis in early stages.
hepatomegaly, splenomegaly, jaundice, wt loss, peripheral edema, ascites, portal HTN, dull pain, n/v, increased abd. girth, pulmonary emboli, portal vein thrombus |
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How is liver cancer diagnosed?
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liver US, CT, MT angiography, hepatic angiography, ERCP, percutaneous biopsy to confirm/guide treatment
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Labs in liver cancer?
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AFP elevation (not a good thing to follow though)
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Prevention of liver cancer?
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treat hep b and c, chronic alcohol use
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treatment of liver cancer?
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surgical excision (if no portal HTN, positive function, no mets, or no invasion of vessels), transplant (local cancer with liver dysfunction), if not resectable: radiofrequency ablation, crytoablation, PEI/PAI, chemo (last option), chemoembolism
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Risks for pancreatic cancer?
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chronic pancreatitis, DM, age, smoking, fam history, high fat diet, exposure to bezidine
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Manifestations of pancreatic cancer?
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dull achy abd. pain, anorexia, rapid wt loss, jaundice (pruritus)
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Diagnosis of pancreatic cancer?
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US/EUS, CT, ERCP, MRI, MRCP
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Labs for pancreatic cancer?
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CA-19-9
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